Child health in England falling behind other European countries

A new report warns child health is lagging behind other European countries, with child mortality potentially 140% higher than other nations by 2030.

The ‘Child health in 2030 in England: comparisons with other wealthy countries’ report, published today by the Royal College of Paediatrics and Child Health (RCPCH), and co-authored by an Imperial researcher, compares England with European and other western countries known as the EU15+.

Our report highlights how serious the state of children's health in England will be by 2030 if alarming current trends continue Dr Dougal Hargreaves Report co-author

Using long-term historical data to project outcomes for children and young people’s health in 2030, it concludes that whilst England is middle of the pack for some outcomes, on the majority England is likely to fall further behind other wealthy countries over the next decade.

Infant mortality in England and Wales rose in 2015 and again in 2016, reversing the 100-year decline in one of the key indicators of population health.  This report reveals that even if infant mortality begins to decline again at its previous rate, infant mortality rates could be 80% higher than the average across the EU15+ in 2030. If mortality continues the current ‘stall’ then it will be 140% higher in 2030.

Dr Dougal Hargreaves, co-author of the report from Imperial's School of Public Health said:"Our report highlights how serious the state of children's health in England will be by 2030 if alarming current trends continue in areas such as infant mortality, childhood obesity, and mental health problems. But there's nothing fixed or inevitable about these projected trends. If expected increases in child poverty aren't addressed, then the actual outcomes in 2030 could be significantly worse than we report. On the other hand, a coordinated and ambitious national strategy for children and young people's health could reverse many of these trends and mean that children in England are given the same opportunities for a healthy life as children in other wealthy countries.

"Recent policies - for example on integrated care and mental health - are an important step in the right direction, but we also need real ambition and commitment from policy makers at all levels to make children and young people a priority."

Worrying findings

The report, which bases projections upon the assumption that recent trends will continue for the next decade, found:

• Mortality: If infant mortality begins to decline again at its previous rate, rates will be 80% higher than the EU15+ in 2030. If UK mortality continues the current ‘stall’ then it will be 140% higher in 2030. Key risk factors for infant mortality are higher in England than in comparable countries – it has higher proportions of young mothers and higher proportions of smoking during pregnancy than most EU15+ countries. Rates of breastfeeding are also concerningly low
• Mental health: Reported mental health problems in England are set to increase by 63% in 2030 if recent trends continue. Around 30% of 11–15-year-olds in England reported being bullied one or more times in the previous two months - if current trends continue, bullying in England will continue close to or above the average across the EU15+ to 2030
• Obesity: Nearly one-third of England’s most deprived boys will be obese in 2030 if the Government’s Childhood Obesity Plan is not implemented
• Accident and emergency attendances: A&E attendances amongst children and young people are set to increase by 50% in 2030
• Outpatient attendance: If current trends continue, there will be a further increase of 48% (16.5 million) in outpatient visits by 2030. This is considerably higher than expected from the population increase projected for the same period (5.1%)

Poverty lies at the root of many risk factors for infant mortality as well as other major child health challenges. Children and young people working with the RCPCH have identified poverty as a major area of concern, particularly with regards to its impact on mental health and nutrition.

Professor Russell Viner, report author and President of the Royal College of Paediatrics and Child Health (RCPCH), said: “Child poverty is predicted to increase over the next decade, which, if true, may make our predictions under-estimates. Children living in poverty are more likely to be obese, have mental health issues and die early.

“We welcome the opportunity provided by NHS England to work with them on proposing how we can improve children and young people’s health in their Long-Term Plan. This Plan must set out a clear vision for delivering world class health and wellbeing outcomes for our next generation.”

The report also highlights where England is predicted to perform to the EU15+ average. Areas include Self-reported injuries, smoking and diabetes control.

Recommendations

The report makes a series of recommendations. These include:

• Children and Young People’s Health Strategy: NHS England to develop and support the implementation of a Children and Young People’s Health Strategy for England in partnership with key arm’s length bodies and sector agency partners. 
• NHS system: Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICS) offer a real opportunity to have a joined-up collaborative approach to health care planning. The RCPCH recommend that each organisation appoints a lead for children and that plans are developed and implemented by working with children, young people and families and by working with social care, education, youth justice and the voluntary sector
• Funding: NHS England should ensure that funding designated for expanding children’s services, e.g. for Child and Adolescent Mental Health Services, reaches frontline services in Clinical Commissioning Groups
• Obesity: opportunistic recording of weight and Body Mass Index (BMI) for all children (2-18) once a year
• NHS England must increase capacity and access to specialist weight management services for children and young people
• Tailored health promotion advice and support for women who smoke, are overweight or misuse substances
• Mental health: NHS England must work with Public Health England and local authorities to ensure all maternity professionals and health visitors are trained to identify maternal mental health problems
• Local child and adolescent mental health systems should be commissioned to cover population need using ‘local offers’ so that they are structured around the child or young person, delivered as close as possible to their home and supported by a family-centred approach to care planning and information sharing
• Healthy start: Investment in health visiting and school nursing services must be increased and protected.

See the press release of this article